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Friday, January 6, 2012

Good and Bad Reasons to Take an Antidepressant



Thirty-five years ago, I received a phone call from my friend Lily about a car accident involving a mutual friend of ours, Terry. The three of us had just graduated from UCLA the week before. Terry, along with her sister, brother-in-law and niece, had gone on a trip to the Colorado River. En route, along a two-lane highway, another vehicle tried to pass them and the line of cars ahead. The driver miscalculated the distance and as a result, a semi-truck coming from the opposite direction swerved to avoid the passing car, struck our friends' car and instantly killed Terry's sister, brother-in-law and niece. Terry survived but suffered severe and irreparable brain damage.
I had given up my apartment following graduation and was briefly staying with my parents before leaving on a long trip. When I came out of my room after the call, deeply upset and in tears, my mother immediately went to her bathroom and returned with a blue, 10 mg Valium tablet which she pressed into my hand. Her response to my grief was to offer me the same medication she used to keep her own pain sedated. I hadn't thought about that incident in years, but recently, in considering some of the wrong reasons people take antidepressants, the memory came back to me.
I believe that antidepressants have their uses, especially in the short-term, but I also believe they are grossly over-prescribed by untrained physicians and medicating psychiatrists who run prescription drug mills. This criticism lays most of the blame at the feet of the medical profession, but a conversation with an old friend from Los Angeles reminded me that insistent patients are just as much a part of the problem. Many people choose to take an antidepressant in order to avoid dealing with a problem they might otherwise have to confront.
My friend -- let's call him Brian -- has worked in the film industry for more than 30 years and knows everybody. Brian told me that he is close with quite a few women who (in his opinion) are on antidepressants because their married life would be otherwise unbearable to them. They're married to wealthy, powerful men in the industry whom they don't love; divorce would mean giving up a financially privileged and superficially glamorous style of life they don't want to relinquish. So they take SSRIs... not because they're depressed but because those drugs make tolerable an emotional situation they wouldn't otherwise be able to bear. Brian says this is not an unusual Hollywood story.
A mutual friend of ours is quite candid about using an antidepressant for similar reasons. She has a child growing up with Asperger's syndrome, and the very low dosage of her medication makes life bearable. She tried getting by without the meds but found she simply couldn't cope. This friend is not struggling with depression per se but with an extremely stressful life situation. Her drugs "take the edge off," numb her out just enough so that she can manage.
Another friend of ours, after her divorce, decided to become an elementary school teacher, though many of us felt she was, by temperament, ill-suited to the profession. Despite some judicious advice, she went ahead with her career change and suffered a nervous collapse during her first year of teaching. With mostly sleepless nights and several panic attacks, she wound up in the emergency room more than once. Instead of reconsidering her career choice and trying to find something more suited to her, she opted for antidepressants instead.
Medication might be the right choice for our friend with the Asperger's syndrome child; after all, as his mother, there isn't much she can do to change her basic lot in life. But in the case of our friend who chose drugs over a career change, it seems to me she's using antidepressants to avoid confronting something dysfunctional in herself and in her life. Likewise, the Hollywood wives who take SSRIs rather than file for divorce are surely using those drugs in ways for which they were never intended.
One of the primary rationales given for using antidepressants is that they may get a depressed mind "unstuck" when psychotherapy is making slow progress; meds are seen as an adjunct to talk therapy, helpful in promoting insight and understanding for the psychotherapy client. But those Hollywood wives and our friend who made a disastrous career choice are using medication for just the opposite reason; they don't want insight so they can understand themselves better and thereby confront important choices. Instead, they're using drugs in order to avoid facing their problems.
Depression, like pain, can be the body's way of telling us that something is wrong. If we listen to our pain and our depression, we might understand what's wrong and over time, figure out what to do about it. But if we reach for the little blue pill as my mother did, numbing the pain instead of confronting it, we remain stuck and will never move forward.
While we're on the subject of antidepressants, you might have read the recent New York Times article written by Peter D. Kramer, author of the famous book Listening to Prozac, which gave an enormous public relations boost to antidepressants when it was first published in 1993. At a time when study after study is questioning the chemical imbalance theory of depression and whether SSRIs have anything other than a placebo effect, Kramer has written an article in their defense. He raises some interesting points about how drug trials are structured and carried out, but for the most part, it struck me as dishonest and self-serving. He criticizes a number of famous studies by name, but resorts to vague language like "studies have shown" when it comes to trials that have reportedly demonstrated the benefits of Prozac and other SSRIs.
From the very beginning, he seems disingenuous, or at least illogical. His initial piece of evidence is entirely anecdotal, about a friend who suffered a stroke and received some benefit from taking an SSRI. According to Kramer, an important study has shown that stroke victims who received Prozac rather than a placebo "recovered more of their mobility. Antidepressants are good at treating post-stroke depression and good at preventing it. They also help protect memory. In stroke patients, antidepressants look like a tonic for brain health."
This is specious argumentation and deceptive prose. It's clear from the quoted passage that the study demonstrated how stroke victims recovered "more of their mobility"; but are the following two sentences the author's opinion or a conclusion of that study? The statement that antidepressants are "a tonic for brain health" is quite a reach. Given that the so-called "antidepressants" are actually stimulants (like cocaine and the tricyclics before them), maybe taking Prozac minimized the damage resulting from a stroke by stimulating the brain during a critical period. That's very different from concluding that Prozac prevents and relieves post-stroke depression. Maybe those stroke victims who benefited from the stimulating effects of Prozac felt less depressed because they recovered more of their mobility.
Joseph Burgo PhD is a clinical psychologist with 30+ years experience in the mental health profession. He writes two blogs, one called 'After Psychotherapy' where he discusses psychotherapy issues such as depression, anxiety, bipolar disorder and borderline personality disorder from a psycho-dynamic perspective; on the other blog, 'Movies and Mental Health' hosted by PsychCentral, he uses classic and contemporary films to illustrate his ideas. Dr. Burgo also offers online counseling via Skype. His forthcoming book on psychological defense mechanisms will be released by New Harbinger Publications in Spring 2013.
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